Provider Demographics
NPI:1922333178
Name:CHOLEWA, PETER (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:CHOLEWA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2956 N MILWAUKEE AVE. SUITE 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7372
Mailing Address - Country:US
Mailing Address - Phone:773-489-0544
Mailing Address - Fax:
Practice Address - Street 1:2956 N MILWAUKEE AVE. SUITE 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7372
Practice Address - Country:US
Practice Address - Phone:773-489-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0215671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice